A HIGH PREVALENCE OF HBV AND HCV INFECTIONS AMONG PREGNANT WOMEN: A PROSPECTIVE CROSS SECTIONAL STUDY

Main Article Content

Abdul Rauf
Muqaddas Tahir
Humaira Abid
Fahad Alshahrani
Muhammad Zahid Latif
Mohammed Merae Alshahrani
Ahmed Abdullah Al Awadh
Nawal E Al-Hazmi
Abdulfattah Omar
Tasleem Akhtar
Syed Ayaz Kazmi
Zeeshan Anjum
Iqra Bibi
Zia-ur-Rehman
Zahoor Iqbal

Keywords

Hepatitis B, Hepatitis C, pregnant women health, risk factors of viral hepatitis, diagnostic associations of viral hepatitis, CBC, BSR, PCR, hepatitis B & C in pregnant women

Abstract

Background: Due to lack of published data from AJ and K state of Pakistan, it is challenging to gain insight into hepatitis B and C prevalence in pregnant women. This research was conducted in an effort to close this knowledge gap and provide the groundwork for future investigations.


Methods: Hepatitis B and C were tested in pregnant women using immuno-chromatographic test and Polymerase Chain Reaction. Blood sugar, LFTs, blood count, risk factors, and knowledge level were also evaluated.


Results: The prevalence of hepatitis B and C infections among pregnant women was found to be 5.2% and 6.4%, respectively. The higher rate of hepatitis B was found in the third trimester and hepatitis C was found in the second trimester. The knowledge level of the participants was less than 20% about viral hepatitis B and C. There were significant associations of hospitalization history (p=0.0003), blood transfusion (p<0.0001), treatment from quacks (p<0.0001), high WBCs (p<0.0001), and low Platelets (p<0.0001) count with hepatitis B and C positivity. However, a higher ALT level (p<0.0001) was only correlated with Anti-HCV prevalence and there was no association of blood sugar level with hepatitis B and C.


 Conclusion: The risk of vertical transmission of HBV and HCV exists in the studied population. Comprehensive treatment of pregnant women for hepatitis B and C, along with HBV vaccination for neonates, is essential to prevent the further spread of these infections.

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References

References
1. World Health Organization. Hepatitis B vaccines. WHO Position Paper Weekly Epidemiological Record 2009, 84(40), 405–20.
2. Ahmad, I.; Khan, S.B.; Rahman, H.U.; Anwar, S.; Hospital, M.E. Frequency of Hepatitis B and Hepatitis C among cataract patients. Gomal J. Med. Sci. 2006, 4, 61–64.
3. Coppola, N.; De-Pascalis, S.; Onorato, L.; Calò, F.; Sagnelli, C.; Sagnelli, E. Hepatitis B virus and hepatitis C virus infection in healthcare workers. World journal of hepatology 2016, 8(5), 273–281.
4. Hofstraat, S. H.I.; Falla, A.M.; Duffell, E.F.; Hahné, S.J. M.; Amato-Gauci, A.J.; Veldhuijzen, I.K.; Tavoschi, L. Current Prevalence of Chronic Hepatitis B and C Virus Infection in the General Population, Blood Donors and Pregnant Women in the EU/EEA: A Systematic Review. Epidemiology and Infection 2017, 145(14), 2873–2885.
5. Geta, M.; Yizengaw, E.; Getaneh, Z.; Getahun, T. Seroprevalence of Hepatitis b Virus Infection among Patients Attending at Addis Alem Primary Hospital, Bahir Dar, Northwest Ethiopia. International Journal of General Medicine 2021, 14, 405–411.
6. Elkhateeb, R.; Hassan, K. Prevalence of hepatitis B and C in pregnant ladies and their neonates in Minia governorate. International Journal of Pregnancy and Child Birth 2018, 4(1), 71–83.
7. Fernandes, C.N. da S.; Alves, M.deM.; de Souza, M. L.; Machado, G. A.; Couto, G.; Evangelista, R. A. Prevalence of Hepatitis B and C Seropositivity in Pregnant Women. Revista da Escola de Enfermagem 2014, 48(1), 89–96.
8. Dabsu, R.; Ejeta, E. Seroepidemiology of hepatitis B and C virus infections among pregnant women attending antenatal clinic in selected health facilities in East Wollega Zone; West Oromia; Ethiopia. BioMed. Research International 2018, 2018, 4792584.
9. Elinav, E.; Ben-Dov, I.Z.; Shapira, Y.; Daudi, N.; Adler, R.; Shouval, D.; Ackerman, Z. Acute Hepatitis A Infection in Pregnancy Is Associated With High Rates of Gestational Complications and Preterm Labor. Gastroenterology 2006, 130, 1129-1134.
10. Hwang, E.W.; Cheung, R. Global epidemiology of hepatitis B virus (HBV) infection. North American Journal of Medicine and Science 2011, 4(1), 7-13.
11. Bancha, B.; Kinfe, A. A.; Chanko, K. P.; Workie, S. B.; Tadese, T. Prevalence of Hepatitis B Viruses and Associated Factors among Pregnant Women Attending Antenatal Clinics in Public Hospitals of Wolaita Zone, South Ethiopia. PLoS ONE 2020, 15(5), e0232653.
12. Bafa, T.A.; Egata, A.D. Seroepidemiological patterns and predictors of hepatitis B; C and HIV viruses among pregnant women attending antenatal care clinic of Atat Hospital. SAGE Open Medicine 2020, 8, 1-9.
13. Molla, S.; Munshea, A.; Nibret, E. Seroprevalence of hepatitis B surface antigen and anti HCV antibody and its associated risk factors among pregnant women attending maternity ward of Felege Hiwot Referral Hospital; Northwest Ethiopia: a cross-sectional study. Virology Journal 2015, 12(1), 1–9.
14. Mamuye, B.; Gobena, T.; Oljira, L. Hepatitis B virus infection and associated factors among pregnant women attending antenatal clinics in West Hararghe public hospitals; Oromia region; Ethiopia. The Pan African Medical Journal 2020, 35, 128
15. Dabsu, R.; Ejeta, E. Seroepidemiology of hepatitis B and C virus infections among pregnant women attending antenatal Clinic in Selected Health Facilities in east Wollega zone; West Oromia; Ethiopia. BioMed. research international 2018, 4792584, 1-9. https://doi.org/10.1155/ 2018/4792584
16. Tsai, M.H.; Lin, K.H.; Lin, K.T.; Hung, C.M.; Cheng, H.S.; Tyan, Y.C.; Huang, H.W.; Sanno-Duanda, B.; Yang, M.H.; Yuan, S.S.; Chu, P.Y. Predictors for Early Identification of Hepatitis C Virus Infection. BioMed. Research International 2015, 429290, 1-7. https://doi.org/10.1155/ 2015/429290
17. Fatima, K.; Ahmad, S.; Bukhari, H.; Ejaz, A.; Ch, S.; Nasir, M. Diagnosis of Hepatitis C Virus Infection in Human Serum Using ELISA and Raman Spectroscopy. Pakistan Journal of Medical and Health Sciences 2022, 16(02), 69-70.
18. World Health Organization. Global Report on Diabetes. World Health Organization; 21 April 2016. https://www.who.int/publications/i/item/9789241565257 (Accessed on 30 June 2023)
19. Hepatitis-B; federal directorate of immunization; Pakistan. (n.d.). 2018. https://epi.gov.pk/ vaccine-preventable-diseases/hepatitis-b/ (accessed on 25 June; 2023)
20. Kazmi, S.A.; Rauf, A.; Alshahrani, M.M.; Awadh, A.A.A.; Iqbal, Z.; Soltane, R.; Tag-Eldin, E.; Ahmad, A.; Ansari, Z.; Zia-ur-Rehman. Hepatitis B among University Population: Prevalence, Associated Risk Factors, Knowledge Assessment, and Treatment Management. Viruses 2022, 14, 1936. https://doi.org/10.3390/v14091936.
21. Casanova, Y. S.; Boeira, T. da R.; Sisti, E.; Celmer, Á.; Fonseca, A. S. K.; Ikuta, N.; Simon, D.; Lunge, V. R. A Complete Molecular Biology Assay for Hepatitis C Virus Detection, Quantifi Cation and Genotyping. Revista da Sociedade Brasileira de Medicina Tropical 2014, 47(3), 287-94.
22. Ugbebor, O.; Aigbirior, M.; Osazuwa, F. The prevalence of hepatitis B and C viral infections among pregnant women. North Am. J. Med. Sci. 2011, 3(5), 238-41.
23. Batool, A.; Akhtar Bano, K.; Ul, M.; Khan, I.; Hussain, R. Antenatal screening of women for Hepatitis B and C in an outpatient department. J. Dow. Univers. Health Sci. 2008, 2, 32–35.
24. Molla, S.; Munshea, A.; Nibret, E. Seroprevalence of hepatitis B surface antigen and anti HCV antibody and its associated risk factors among pregnant women attending maternity ward of Felege Hiwot Referral Hospital; northwest Ethiopia: a cross-sectional study. Virol. J. 2015, 12, 204.
25. Ahmad, I. Prevalence of Hepatitis B and C Viral Infection Among Pregnant Women in Peshawar; Pakistan. Hepat Mon. 2016, 16(6), e36383.
26. Zahid, A.; Awais, H.; Bashir, F.; Mannan, T.; Afzaal, A.; Khokhar, N. Prevalence of Hepatitis B&C in Pregnant Females and Transmission through Sporadic Source and Dental Source among Pakistani Population: A Brief Review. Pakistan Journal of Medical and Health Sciences 2023, 17(2), 8–12.
27. Naseeb, S.; Rashid, S.; Dehar, S. Frequency of Hepatitis B and C and its Risk Factors in Pregnant Women Presenting at Jinnah Postgraduate Medical Center; Karachi. Pakistan Journal of Health Sciences 2023, 4(3), 83–87.
28. Pokrovsky, V.I.; Totolyan, A.A.; Viral hepatitis in Russian Federation: Analytical review. 10th edition. St. Petersburg: FBUN NIIEM named after Pasteur. 2016, p 152.
29. Ershova, O.N.; Shakhgildyan, I.V.; Kuzin, S.N. et al. Characteristics of perinatal transmission activity of the hepatitis C virus. Epidemiology and infectious diseases 2005, 1, 39–41.
30. Israr, M.; Ali, F.; Nawaz, A.; Idrees, M.; Khattak, A.; Rehman, S. U.; Azizullah, A.; Ahmad, B.; Bano, S. A.; Iqbal, R. Seroepidemiology and Associated Risk Factors of Hepatitis B and C Virus Infections among Pregnant Women Attending Maternity Wards at Two Hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan. PLoS ONE 2021, 16(8) e0255189.
31. Pandey, S.; Lohani, P.; Roy, R.; Bhar, D.; Ranjan, A.; Kumar, P.; Singh, C. Prevalence and Knowledge of Hepatitis B Infection in Pregnant Women in a Primary Health Center of Patna District, Bihar. Journal of Family Medicine and Primary Care 2021, 10(10), 3675-3681.
32. Jindal, N.; Goyal, L.D.; Singh, C. Sociodemographic features associated with Hepatitis C Virus (HCV) in pregnant females: A tertiary care centre study from Malwa region of Punjab (North India). Journal of Family Medicine and Primary Care 2021, 10(7), 2679-2683.
33. Ruiz-Extremera, Á.; Díaz-Alcázar, M.d.M.; Muñoz-Gámez, J.A.; Cabrera-Lafuente, M.; Martín, E.; Arias-Llorente, R.P.; et al. Seroprevalence and epidemiology of hepatitis B and C viruses in pregnant women in Spain. Risk factors for vertical transmission. PLoS ONE 2020, 15(5), e0233528. https://doi.org/10.1371/journal.pone.0233528.
34. Molnar, G.B.; Leentvaar-Kuijpers, A.; Hausman B.A. Prevalence of HBsAg among parturient pregnant women in northwestern Romania. Eur. J. Public Health 1995, 5(3), 223–225. DOI: 10.1093/eurpub/5.3.223.
35. Simon, L.; Renaldo, F.; Hans L.T. Prevalence of Hepatitis B among Pregnant Women and Its Impact on Pregnancy and Newborn Complications at a Tertiary Hospital in the Eastern Part of Germany. Digestion 2010, 83(1-2), 76–82. DOI: 10.1159/000320455.
36. Shaikh, O.A.; Aaqil, S.I.; Kumar, P. Pakistan’s struggle to tame hepatitis: an ongoing threat. International Journal of Surgery: Global Health 2023, 6(2), e123.
37. National Hepatitis Elimination Profile for Pakistan: Key Takeaways. 21 June 2022. https://www.globalhep.org/news/national-hepatitis-elimination-profile-pakistan-key-takeaways (Accessed on 25 June 2023).
38. Yousafzai, M.T.; Qasim, R.; Khalil, R.; Kakakhel, M.F.; Rehman, S.U. Hepatitis B vaccination among primary health care workers in Northwest Pakistan. Int J Health Sci (Qassim) 2014, 8(1), 67-76.
39. Attaullah, S.; Khan, S.; Naseemullah; Ayaz, S.; Khan, S. N.; Ali, I.; Hoti, N.; Siraj, S. Prevalence of HBV and HBV Vaccination Coverage in Health Care Workers of Tertiary Hospitals of Peshawar, Pakistan. Virology Journal 2011, 8, 275.
40. Ali, S. A.; Donahue, R. M. J.; Qureshi, H.; Vermund, S. H. Hepatitis B and Hepatitis C in Pakistan: Prevalence and Risk Factors. International Journal of Infectious Diseases 2009, 13(1), 9–19.
41. Karmen, A.; Wróblewski, F.; LaDue, S. Transaminase activity in human blood. The Journal of Clinical Investigation 1955, 34(1), 126–131.
42. Wang, C.S.; Yao, W.J.; Wang, S.T.; Chang, T.T.; Chou, P. Strong Association of Hepatitis C Virus (HCV) Infection and Thrombocytopenia: Implications from a Survey of a Community with Hyperendemic HCV Infection. Clinical Infectious Diseases 2004, 39(6), 790–796.
43. Kitchens, C.S. Thrombocytopenia and thrombosis in disseminated intravascular coagulation (DIC). Hematology American Society of Hematology Education Program 2009, 2009(1), 240–246. https://doi.org/10.1182/asheducation-2009.1.240
44. Fasola, F.A.; Babalola, O.A.; Odaibo, G.N. Haematological Changes Associated with Hepatitis B Virus Infection in Individuals with and without Sickle Cell Disease. West Afr. J. Med. 2021, 38(12), 1167-1173.
45. Christine, Y.C; Leslie, K.; Nolan, D.; Ramsey, C.; Mindie, H.N. ALT Levels in Treatment-Naive; Chronic Hepatitis B Patients with Concurrent Fatty Liver Disease: A US Nationwide Study. Dig. Dis. 2022, 40(4), 497–505.
46. Nwokediuko, S.C.; Ibegbulam, O. Quantitative Platelet Abnormalities in Patients with Hepatitis B Virus-Related Liver Disease. Gastroenterology Res. 2009, 2(6), 344-349.
47. Chehadeh, W.; Al-Nakib, W. Severity of liver disease predicts the development of glucose abnormalities in patients with chronic hepatitis B or C following achievement of sustained virological response to antiviral therapy. J. Med. Virol. 2009, 81(4), 610-8.
48. Li; Y.; Wang; X.; Yu; G.; Sun, H.; Lv, J.; Chi, X.; Wu, R.; Gao, X.; Niu, J. The association of hepatitis c virus infection status with serum glucose levels. B.M.C. Gastroenterology 2019, 19, 86. https://doi.org/10.1186/s12876-019-1003-3
49. Hepatitis B Foundation. Living with hepatitis B and diabetes, 29 Nov 2022. https://www.hepb.org/blog/living-hepatitis-b-diabetes/ (Accessed on 25 June 2023).
50. Shawky, M.; Mohammed, A.Q.; Hassan, A. Insulin resistance in nondiabetic Egyptian patients with chronic hepatitis C virus. Revista De Gastroenterología De México. 2020, 85(2), 173-179. https://doi.org/10.1016/j.rgmxen.2019.05.007
51. Jing, W.; Zhao, S.; Liu, J.; Liu, M. ABO blood groups and hepatitis B virus infection: a systematic review and meta-analysis. B.M.J. Open 2020, 10(1), e034114.
52. Mahnoor, N.; Imran, M.; Safi, M.; Bashir, S.Z.; Alkhuriji, M.A.; Alomar, S.Y.; Alharbi, H.M. Association of blood groups with hepatitis C viremia. Saudi Journal of Biological Sciences 2021, 28(9), 5359–5363.
53. Gul, F.; Savul, S.; Aamir, R.; Zehra, T.; Mujtaba, H.; Sadiq, F. Knowledge and awareness of Hepatitis B; Hepatitis C; and HIV among pregnant women in Pakistan. The Journal of Infection in Developing Countries 2022, 16(9), 1512-1516.
54. Mudji, J.; Madinga, B.; Horsmans, Y. Seroprevalence of Viral Hepatitis B and C and Knowledge of the Hepatitis B Virus among Pregnant Women Attending Prenatal Care in the Democratic Republic of Congo. The American Journal of Tropical Medicine and Hygiene 2021, 104(3), 1096-1100.

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